Healthcare Provider Details

I. General information

NPI: 1669991972
Provider Name (Legal Business Name): ELIZABETH WHETZEL SAVAGE RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W 52ND ST
NEW YORK NY
10019-6239
US

IV. Provider business mailing address

40 E 78TH ST APT 3A
NEW YORK NY
10075-1830
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2100
  • Fax:
Mailing address:
  • Phone: 917-399-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number008887-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number008887-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number008887-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008887-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: